HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: iA�, 2z Permit Number: 270 6
RECEIVED
Building Permit Application JUN 2 3 2017
Planning and Development Services
Building and Code 1?6ulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1 1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropb p' x, click arrow at the end of line
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Address:
Legal Description: 11n�4DAY PIA)r_7S J-IL') 07_ 21a?jo
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Property Tax ID#: 00 7'�Q— 00v Lot No. 4Rb
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional work tobe nertormed uncier tnis permit—check 4!1 Via apply:
0HVAC 13 Gas Tank F]Gas Piping F1
Electric F�Plumbing E]Sprinklers _Shutters Windows/Doors
Generator Roof Roof pitch
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Total Sq. Ft of Construction: 3;22Ft.of First Floor:
Cost of Construction:$ Utilities: []Sewer F—]Septic Building Height:
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tlAj�� Name: dhb)11t1,fL SIDIN C-7 elf 1,
Name AA 64,0
Address: C-1 %;6mpany`?� .139" tkLAJ
Address:-,
City State: d A'd ress: , owT#
Zip Code: Fax:— City: 7— SI�T 4—W A5 State:_E�_
Phone No.-7-72 Q&6-- QrV? ?ip Cocle:.R(/9_5o Fax: 33,5--
E-Mail: Phone N
Fill in fee simple Title Holder on next page(if different M a 11: Yl
from the Owner listed above) State or County License: QU51 S
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER,: _Not Applicable
MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: f Address:
city: City:
Zip: 1 Phone: Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize thepermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,Iswimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property.A Notice of Commencement must be recorded and post9d on the jobsite
before the first inspection. If you intend to obtain financing, consu th lender or an at o ney before
commencing work or recording our Notice of Commenceme
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ture n essee Contractor as Agent for Owner Signature of Contractor/License Hold
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TEFL IDA STATE OF FLORIDA
COUNTY OF I ST tue-19 COUNTY OF S? LGICI�
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The for o' instrument was acknowledged before me The for�i.ng instrument was acknowledged before me
tI, y of TIM)IS, 20 Llby thi��z'day of �u�� 20 �by
Vy(KILYOU I+AUL Bimp 1706-MAJ
(Name of person acknowledging) (Name of person acknowledging
)�M�ar` a � xA
( ignature of No � Pu lic-State of Florida) (Signature of Notary P ic-State of Florida)
Personally Known OR Produced Identification F L Personally Known_k OR Produced Identification
Type of Identification Produced-H y00-W&J - �M(J Type of Identification Produced
Commission No. F Seal Commission No. �.33 (Seal)
yr Notary puWic State o!Florida Note Public State at Florida
MY Commission FF 981331
Revised 07/15/21 14 0.c1rFxpires05d18 O20J,
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS